Artificial teeth selection & Artificial teeth selection & arrangementarrangement

Artificial teeth selection & Artificial teeth selection & arrangementarrangement

• Appearance &function Can not be restored with artificial teeth unless they are placed in the position was formerly occupied by the natural teeth .

• Goals of teeth arrangement:

• to have front teeth look good.

• Allow the patient to speak clearly.

• To have all the teeth positioned for

best function ,

comfort ,stability &

retention of dentures.

• Appearance &function Can not be restored with artificial teeth unless they are placed in the position was formerly occupied by the natural teeth .

• Goals of teeth arrangement:

• to have front teeth look good.

• Allow the patient to speak clearly.

• To have all the teeth positioned for

best function ,

comfort ,stability &

retention of dentures.

• Complete denture tooth position & selection is guided by anatomical landmarks recorded in

• impression (models) &• during registration(occ.rim)

• Complete denture tooth position & selection is guided by anatomical landmarks recorded in

• impression (models) &• during registration(occ.rim)

Reference Marks for Selecting Reference Marks for Selecting Anterior TeethAnterior Teeth

Reference Marks for Selecting Reference Marks for Selecting Anterior TeethAnterior Teeth

• Technician sets the teeth without seeing patientTechnician sets the teeth without seeing patient

• Wax rim contours aid selection and settingWax rim contours aid selection and setting

• Land marks on the occlusal rim during registration:Land marks on the occlusal rim during registration:

- up.& l. labial contours(Angulation of facial rims affects up.& l. labial contours(Angulation of facial rims affects lip support)lip support)

– -midline-midline

– Occlusal vertical dimensionOcclusal vertical dimension

– -smile lip line( high lip line is marked on occlusion rim -smile lip line( high lip line is marked on occlusion rim when the patient smiles)when the patient smiles)

– Canine prominenceCanine prominence

• Technician sets the teeth without seeing patientTechnician sets the teeth without seeing patient

• Wax rim contours aid selection and settingWax rim contours aid selection and setting

• Land marks on the occlusal rim during registration:Land marks on the occlusal rim during registration:

- up.& l. labial contours(Angulation of facial rims affects up.& l. labial contours(Angulation of facial rims affects lip support)lip support)

– -midline-midline

– Occlusal vertical dimensionOcclusal vertical dimension

– -smile lip line( high lip line is marked on occlusion rim -smile lip line( high lip line is marked on occlusion rim when the patient smiles)when the patient smiles)

– Canine prominenceCanine prominence

Maxillary Reference MarksMaxillary Reference MarksMaxillary Reference MarksMaxillary Reference Marks

Midline PositionMidline PositionMidline PositionMidline Position

• Critical reference

• #7 wax spatula

• Score a line parallel the facial midline

• Mark both rims

• Critical reference

• #7 wax spatula

• Score a line parallel the facial midline

• Mark both rims

• Mark midline on the wax• Mark midline on the wax

Midline of Teeth = Facial Midline of Teeth = Facial MidlineMidline

Midline of Teeth = Facial Midline of Teeth = Facial MidlineMidline

Guidelines for Guidelines for Setting Anterior Setting Anterior

TeethTeeth

Guidelines for Guidelines for Setting Anterior Setting Anterior

TeethTeethHigh Lip LineHigh Lip Line

Corner of Corner of MouthMouth

Angulation is as Angulation is as important as important as midlinemidline

High Lip Line

• Highest point of upper lip when smiling

• Cervical necks lie at or above this line

• If shorter teeth are selected, esthetics compromised

• The 4 landmarks which is determined in stone models :1-max.incisive papilla → guide to midline for max. central

incisor& position of incisor & cuspid2-mandibular premolar ridge →guide the buccolingual position

of premolar3-RMPretromolar pad height &4- width → guide the height &

width of posterior teeth

Palatal MidlinePalatal MidlinePalatal MidlinePalatal Midline

• Through middle of incisive papilla & mid-palatal raphe

• Extend onto land area

• Check for symmetry

– If not symmetrical, adjust rim

• Through middle of incisive papilla & mid-palatal raphe

• Extend onto land area

• Check for symmetry

– If not symmetrical, adjust rim

Midline & Canine ReferenceMidline & Canine ReferenceMidline & Canine ReferenceMidline & Canine Reference

• Line passing through distal of incisive papilla

• Perpendicular to the palatal midline

• Intersects cusp tips of the canines

• Line passing through distal of incisive papilla

• Perpendicular to the palatal midline

• Intersects cusp tips of the canines

Natural Natural DentitioDentitionn

Distal Aspect of the Incisive Papilla

• The papilla is used in locating the anterioposterior position of max.ant. teeth (incisal edges are usually 8-10mm anterior to the center of papilla)

• Canines tips should be located in coronal plane passing through posterior border of papilla

Mandibular Reference Lines

aa

1/2 way up1/2 way upretr omolarretr omolar

Center of ridgeCenter of ridgePosteriorPosterior

Center of ridgeCenter of ridgeAnteriorAnterior

MandibularCast

Land AreaLand Area

Occlusion rimOcclusion rim

aa

1/2 way up1/2 way upretr omolarretr omolar

Center of ridgeCenter of ridgePosteriorPosterior

Center of ridgeCenter of ridgeAnteriorAnterior

MandibularCast

Land AreaLand Area

Occlusion rimOcclusion rim

Setting Anterior TeethSetting Anterior Teeth

Setting Anterior TeethSetting Anterior TeethSetting Anterior TeethSetting Anterior Teeth

– Incisal edges of central incisors & canines at level of the occlusal plane

– Incisal edges of central incisors & canines at level of the occlusal plane

Max. central incisors are critical teeth to set: as they are the most visible ,establish midline, provide esthetic support of patient’s lip.

The contact point should coincide with the midline of the face.. The incisal edge should touch the mandibular occlusion rim.

The long axis of the tooth should be perpendicular to the horizontal plane (occlusal plane or the mandibular occlusion rim

1. The long axis should incline

slightly distally.

2. The cervical portion of the

tooth should incline slightly

lingually.

3. The incisal edge of the lateral

should be raised

approximately 1 mm from

the mandibular occlusion

rim.

1. The long axis should incline

slightly distally.

2. The cervical portion of the

tooth should incline slightly

lingually.

3. The incisal edge of the lateral

should be raised

approximately 1 mm from

the mandibular occlusion

rim.

1. The incisal edge of the canine should touch the mandibular occlusion rim.

2. The long axis should be perpendicular to the occlusal plane. The cervical third of the labial portion of the canine should incline buccally to achieve some prominence.

3. The mesiolabial aspect of the canine should be visible when viewed from the anterior. This will be accomplished by tilting the neck of the canine slightly to the distal (in addition to being tilted to the buccal).

Arrangement of Anterior Teeth

The canine is an important tooth as it forms the corner of the dental arch , max. canine has two planes on facial surface; mesial plane should follow the contour of ant. Teeth

while distal plane will be in line with posterior teeth. Place the canine so that the anterior one half of incisal edge is in symmetry with lateral

& central incisors as it curve around the labial contour of wax

Arrangement of Anterior Teeth Dr Ban Ahmed Abdul Hameed

When viewed facially, all maxillary anterior teeth are When viewed facially, all maxillary anterior teeth are tilted mesially, with the lateral incisor inclined the most tilted mesially, with the lateral incisor inclined the most and raised about 1 mm above the plane. When and raised about 1 mm above the plane. When viewed laterally, the incisors are depressed at the viewed laterally, the incisors are depressed at the cervical, with the lateral incisor being the most cervical, with the lateral incisor being the most depressed, and the canine being straight with the long depressed, and the canine being straight with the long axis perpendicular to the occlusal plane. axis perpendicular to the occlusal plane.

Bucco-Lingual TiltBucco-Lingual Tilt Maxillary Anterior TeethMaxillary Anterior Teeth

Bucco-Lingual TiltBucco-Lingual Tilt Maxillary Anterior TeethMaxillary Anterior Teeth

• Facial surface of central is

perpendicular occlusal plane

• Neck of lateral is depressed

• Neck of canine is prominent

• Facial surface of central is

perpendicular occlusal plane

• Neck of lateral is depressed

• Neck of canine is prominent

Central Canine

Circumference Follows Arch Circumference Follows Arch ShapeShape

Circumference Follows Arch Circumference Follows Arch ShapeShape

Maxillary Canines

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The canine has two planes on The canine has two planes on the labial surface [a mesial the labial surface [a mesial plane and a distal plane]. When plane and a distal plane]. When viewed from the anterior viewed from the anterior only only the mesial plane should be the mesial plane should be visible.visible.

Note the prominence of the gingival third of max. incisors &canines. This gingival third is primarily responsible of lip supportDepressing gingival third causes the upper lip to have flaccid appearance.

When viewed from the When viewed from the occlusal the anterior teeth occlusal the anterior teeth follow the curvature of the follow the curvature of the internal portion of the land internal portion of the land area.area.

Setting of all maxillary anterior teethSetting of all maxillary anterior teeth

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Melt the wax in the area where Melt the wax in the area where the section was removed with a the section was removed with a hot instrument. Set the hot instrument. Set the maxillary central incisor, being maxillary central incisor, being careful to not disturb the careful to not disturb the midline as recorded by the midline as recorded by the remaining section of wax rim. remaining section of wax rim. Check its position with a flat Check its position with a flat plate.plate.

Note that the central incisor contacts the flat plate Note that the central incisor contacts the flat plate resting on the occlusal plane. resting on the occlusal plane.

Set the rest of the anterior teeth on the right side Set the rest of the anterior teeth on the right side according to the curve defined by the plastic ruler. according to the curve defined by the plastic ruler. The labioincisal line angle of the incisors should The labioincisal line angle of the incisors should touch the ruler, as well as the midbuccal surface of touch the ruler, as well as the midbuccal surface of the canine. the canine.

Note that the lateral incisor Note that the lateral incisor is set about 1mm above the is set about 1mm above the occlusal plane.occlusal plane.

……then check to make sure then check to make sure the alignment is correct with the alignment is correct with the contour of the wax rim, the contour of the wax rim, using a flexible ruler.using a flexible ruler. Set the teeth on the right Set the teeth on the right side following the same side following the same procedures.procedures.

An anterior view of the maxillary anterior teeth shows An anterior view of the maxillary anterior teeth shows that only the lateral incisors do not touch the occlusal that only the lateral incisors do not touch the occlusal plane . With the maxillary anterior teeth set, the patient’s plane . With the maxillary anterior teeth set, the patient’s midline is recorded and proper labial support is midline is recorded and proper labial support is established.established.

The anterior teeth should not be positioned any The anterior teeth should not be positioned any further forward than the depth of the labial vestibule, further forward than the depth of the labial vestibule, determined by a line drawn from the depth of the determined by a line drawn from the depth of the vestibule and perpendicular to a line drawn parallel vestibule and perpendicular to a line drawn parallel to the occlusal plane. The depth of the vestibule is to the occlusal plane. The depth of the vestibule is the fulcrum point and the further forward a tooth the fulcrum point and the further forward a tooth extends beyond this point, the greater are the forces extends beyond this point, the greater are the forces that tend to dislodge the denturethat tend to dislodge the denture. .

Setting Mandibular Anteriors

Lower anterior teeth incline similar to the maxillary teeth

a. Mandibular central incisors

1. The long axis of the mandibular central incisor should be set perpendicular to the occlusal plane.

2. The contact point of mandibular incisors should coincide with the midline of the maxillary teeth.

3. Set the mandibular central incisors so that the maxillary incisors cover them, 1 mm vertically and 1 mm horizontally (1 mm horizontal and vertical overlap).

b. Mandibular lateral incisors

1.The long axis of the mandibular incisor should be slightly inclined distally at the cervical portion of the tooth.

2.The occlusal height should be the same at the central incisors.

Arrangement of Anterior Teeth

c. Mandibular canines

1.The long axis of the mandibular canine is nearly perpendicular to the occlusal plane with a slight distal inclination.

2.The tip of the canine should be at the same occlusal height as the mandibular central and lateral incisors.

For the standard setup : complete denture is designed with small overbite/ovejet so as to minimize dislodging forces on excrusionsSo it is preferable to set the lower ant. teeth just out of contact & this is accomplished by setting mand. Ant. Slightly down & back(1mmof overjet)

Vertical overlap 1 mmVertical overlap 1 mm(Overbite)(Overbite)

Horizontal overlap 1-2 mmHorizontal overlap 1-2 mm(Overjet)(Overjet)

Horizontal overlap is measured from the maxillary palato-Horizontal overlap is measured from the maxillary palato-incisal line angle to the mandibular labio-incisal line angle.incisal line angle to the mandibular labio-incisal line angle.

Mandibular Central Incisors

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When properly arranged, the long axis of the maxillary canine will coincide with the distal surface of the mandibular canine, when viewed from the facial.Alternatively, the mandibular canines can be arranged first in the proper relationship to the maxillary canines ( the cusp tip of the mandibular canine is placed between the maxillary canine and lateral). You then arrange the centrals and laterals in the remaining space.

Mandibular Canines

The canine is slightly inclined to The canine is slightly inclined to the distal whereas the lateral the distal whereas the lateral incisor is relatively vertical.incisor is relatively vertical.

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Setting of all mandibular anterior teethSetting of all mandibular anterior teeth

From the anterior viewFrom the anterior view, the angulation of the , the angulation of the mandibular anterior teeth should be as indicated. mandibular anterior teeth should be as indicated.

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Arrangement of Anterior Teeth Dr. marwah salah